NYTimes: The Doctor Is Out. For Good.

I HAD heard stories of doctors disappearing — gone, suddenly, their offices closed and no forwarding address to be found — but I never expected it from my physician of 12 years. After weeks of phoning his office, I finally reached him. He referred to himself in the third person: Dr. J. was unavailable, the practice was closing and if I wanted my medical records, I should come fetch them.
This was a man who had peered into my nose and mouth, performed prostate examinations and talked me through afflictions. He knew I was married, had children, and what I did for a living. That he would skip town without notice seemed an abrupt ending. He didn't even tell my health insurance provider that he had shut his doors.

When I arrived the next day, the doctor handed me my records and said he was closing the practice and moving it to Texas. He had not notified anyone because there were too many patients to contact, an explanation I accepted without contention, the way I had adopted so much of his advice over the years.

Everyone seems to have a health care provider they swear by — a dentist who can pull teeth without painkillers, a chiropractor who can realign spines one-handed. "My doctor is the best," I've heard countless friends say. Rarely do they say "my doctor is the worst" — partly because people don't usually stay with bad doctors very long, but also because bad doctors aren't always obvious, at least until they do something obviously bad. Like, say, suddenly closing their practice and relocating 2,000 miles away.

More ..l

http://www.nytimes.com/2015/12/26/opinion/the-doctor-is-out-for-good.html?

NYTimes: A Surgery Center That Doubles as an Idea Lab

From the moment patients register at Memorial Sloan Kettering Cancer Center's new $300 million, state-of-the-art outpatient surgery center on the Upper East Side of Manhattan, they will be taking part in a test bed for emerging ideas in patient experience design, health care technology and data tracking.

Instead of waiting in a long line to register, patients at the new center, the Josie Robertson Surgery Center, will be handed plastic tracking badges that will broadcast their locations in real time, allowing intake coordinators to come directly to them wherever they are sitting. Inspired by modern hotel lobbies and co-working spaces, the family waiting room has semiprivate seating areas and mobile device charging stations. And for people who become antsy while their loved ones are in surgery, there is an Xbox nook for fitness activities.

Operating rooms, too, incorporate "the most advanced technology," according to marketing materials, including the latest surgical robots and "super-high-definition monitors" to display anatomical imaging.

More ...

http://www.nytimes.com/2015/12/27/technology/a-surgery-center-that-doubles-as-an-idea-lab.html?smprod=nytcore-ipad&smid=nytcore-ipad-share

At a Memorial Sloan Kettering outpatient surgery center in Manhattan, innovations include data tracking and other techniques to improve care, but some worry about transparency.

NYTimes: Why Physicians Need ‘Right Compassion’

As a young doctor working in the E.R. my capacity for compassion, and that of my colleagues, was often stretched; this was particularly the case when my patients could be said to have brought misfortune on themselves. I saw drug addicts suffering overdose, teenagers retching after self-poisoning, thieves injured through being arrested, all treated more brusquely than other theoretically more blameless patients.

I tried hard to maintain empathy, reflecting that the overdosed, self-poisoned and criminal may no more have brought their problems on themselves than those with skiing or horse-riding injuries or heart palpitations through overwork. But it's complicated: I've stitched up many slashed wrists cut not through willfulness but as a release from intense anguish; I've attended alcoholics for whom alcohol was clearly a substitute for love. I may not have always succeeded, but I always hoped that my humanity, or my professional duty to provide a high standard of care, would step in when my compassion was running low.

Compassion means "together-suffering" or "fellow-feeling" — a sense of identification we feel when imagining another's pain. The word "patient" means "sufferer," and at its most basic level the practice of medicine could be described as the attempt to ease mental and physical pain. If physicians have a surfeit of compassion — if they're too sentimental, or too thin-skinned — they do their jobs slowly, even less effectively. I've worked with colleagues like this: They don't last long in the pressurized environment of the E.R. or the primary care clinic.

More ...

http://www.nytimes.com/2015/12/26/opinion/why-physicians-needright-compassion.html?

Patient Care: Doctors Can Ease Patient Suffering By Asking 'What's The Worst Part Of This?'

Modern medicine in the Western world relies primarily on treating existing illnesses with drugs or unnecessary procedures and a quick turnaround in the doctor's office in order to treat more people. In the midst of all this hectic chaos, doctors will skim over a patient's record and medical history, get a mere glimpse into their emotional lives, and leave mental health care to the side.

But Dr. Ronald Epstein, a University of Rochester professor, wants to change the way doctors approach their patients. Suffering is seen in all corners of hospitals and medical centers — from the emotional pain of a mother who just lost an unborn baby to an older man facing a terminal illness, yet doctors often don't address it.

In a new essay published in the Journal of the American Medical Association, Epstein and a co-author, oncologist Anthony Back of the University of Washington, reviewed medical literature on the ways doctors approach suffering. They found that an approach to suffering is rarely discussed in the medical world, and that this needs to change.

"Physicians can have a pivotal role in addressing suffering if they can expand how they work with patients," the authors wrote. "Some people can do this instinctively, but most physicians need training in how to respond to suffering — yet this kind of instruction is painfully lacking."

Epstein and Back note that physicians can improve their approach by listening to the patient and learning about his/her experience. In addition to the typical "diagnosing and treating," the authors argue that doctors should also "turn toward" the patient, and recognize their suffering. They can do that by asking questions like, "What's the worst part of this for you?" Sometimes an acknowledgment that their pain is real, and that it matters to someone, is all a patient needs to open up.

More ...

http://www.medicaldaily.com/patient-care-doctors-can-ease-patient-suffering-asking-whats-worst-part-366464

NYTimes: When Hospital Paperwork Crowds Out Hospital Care

A FRIEND was recently hospitalized after a bicycle accident. At one point a nursing student, together with a more senior nurse, rolled a computer on wheels into the room and asked my friend to rate her pain on a scale of 1 to 10.
She mumbled, "4 to 5." The student put 5 into the computer — and then they left, without further inquiring about, or relieving, my friend's pain.
This is not an anecdote about nurses not doing their jobs; it's an illustration of what our jobs have become in the age of electronic health records. Computer documentation in health care is notoriously inefficient and unwieldy, but an even more serious problem is that it has morphed into more than an account of our work; it has replaced the work itself.
Our charting, rather than our care, is increasingly what we are evaluated on. When my hospital switched to bar code scanning for medication administration, not only were the nurses on my floor rated as "red," "yellow" or "green" based on the percentage of meds we scanned, but those ratings were prominently and openly displayed on printouts left at the nurses' station.
Or consider "fall assessments," which a nurse uses to determine a patient's risk of falling while in the hospital — a problem that accounts for 11,000 deaths annually. The assessments ask about medication, mobility issues and confusion to create a "fall risk score," which then generates an appropriate menu of interventions.
A nurse could spend 10 minutes documenting a patient's fall risk, or 10 minutes trying to keep patients from falling. It seems obvious that a computer record of "fall risk" cannot in and of itself prevent falls, but completing those records is considered essential in hospitals. As a result, real fall-prevention efforts — encouraging patients to use the call light, ordering a bedside commode, having an aide do hourly check-ins — get short shrift.

More ...

http://www.nytimes.com/2015/12/20/opinion/sunday/when-hospital-paperwork-crowds-out-hospital-care.html?